Division of Hospital Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA,
Heart Fail Rev. 2014 Mar;19(2):199-205. doi: 10.1007/s10741-013-9371-1.
Case reports have documented reversible cardiac dysfunction in the setting of severely depressed extracellular calcium concentrations. The present systematic review and meta-analyses of individual patient data were conducted to further characterize the cardiac dysfunction associated with low serum calcium levels in the clinical setting. We searched Ovid MEDLINE, Embase, PubMed databases and the Cochrane Library and the Registry of Clinical Trials from 1948 through August 2011. Studies that evaluated low serum calcium and cardiac dysfunction were identified and included for review. A total of 43 studies comprised of 47 individual cases met inclusion criteria. Univariate linear regression analysis showed a statistically significant correlation between corrected QT interval (QTc) length and corrected total serum calcium level (B = -23.19, SE = 8.04, P = 0.01), left ventricular ejection fraction and corrected total serum calcium (B = 5.16, SE = 1.29, P < 0.01) and ionized serum calcium (B = 5.48, SE = 2.04, P = 0.03). Hypocalcemia may be associated with reversible cardiac dysfunction including QTc interval prolongation and depressed left ventricular systolic function. The available evidence is very limited and does not provide a rationale for a certain threshold or a recommendation for calcium replacement. Future research is needed in this important and common metabolic disorder.
病例报告记录了严重低细胞外钙浓度时可出现可逆性心脏功能障碍。本研究对个体患者数据进行了系统回顾和荟萃分析，旨在进一步明确临床低血钙与心脏功能障碍之间的关系。我们检索了 1948 年至 2011 年 8 月间的 Ovid MEDLINE、Embase、PubMed 数据库和 Cochrane 图书馆及临床试验注册库。评估低血钙和心脏功能障碍的研究被识别并纳入综述。共 43 项研究，包括 47 个独立病例，符合纳入标准。单变量线性回归分析显示校正 QT 间期（QTc）长度与校正总血清钙水平（B = -23.19，SE = 8.04，P = 0.01）、左心室射血分数与校正总血清钙（B = 5.16，SE = 1.29，P < 0.01）和离子化血清钙（B = 5.48，SE = 2.04，P = 0.03）之间存在显著相关性。低钙血症可能与可逆性心脏功能障碍相关，包括 QTc 间期延长和左心室收缩功能下降。现有证据非常有限，不能为特定阈值或补钙治疗提供依据。这种常见的代谢紊乱需要进一步开展相关研究。
